Cerebrospinal fluid drainage and steroids provide better spinal cord protection during aortic cross-clamping than does either treatment alone.
We investigated whether intravenous methylprednisolone (30 mg/kg) before 30 minutes of aortic cross-clamping and after 4 hours could enhance the effects of cerebrospinal fluid drainage on spinal cord perfusion pressure and postoperative paraplegia when proximal blood pressure was controlled with sodium nitroprusside and partial exsanguination. Dogs were randomized into three groups: group 1 (n = 6), control; group 2 (n = 7), steroids; and group 3 (n = 6), steroids with cerebrospinal fluid drainage. During aortic cross-clamping, blood pressure proximal to the clamp decreased significantly in each group compared with baseline (p less than 0.05), but did not differ among groups (group 1 = 82.2, group 2 = 82.1, group 3 = 86.6 mm Hg, p greater than 0.05). Mean distal pressure decreased from systemic values to 8.4, 8.5, and 3.7 mm Hg, respectively, after aortic cross-clamping (p less than 0.05); these values did not differ from one another (p greater than 0.05). During aortic cross-clamping, cerebrospinal fluid pressure in groups 1 and 2 did not differ significantly compared with baseline (12.2 versus 8.2, 14.2 versus 10.7 mm Hg, p greater than 0.05), whereas in group 3 the baseline cerebral spinal fluid pressure of 10.7 mm Hg decreased to 0.4 mm Hg (p less than 0.05). Spinal cord perfusion pressure in group 3 was significantly higher than in groups 1 and 2 (3.3 versus -3.9 and -5.7 mm Hg, p less than 0.05), but did not differ between groups 1 and 2 (p greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Woloszyn
T T
TT
Department of Surgery, Maimonides Medical Center, Brooklyn, NY 11219.
Marini
C P
CP
Coons
M S
MS
Nathan
I M
IM
Basu
S
S
Acinapura
A J
AJ
Cunningham
J N
JN
D000818:Animals; D001011:Aorta / Q000502:physiology*; D001794:Blood Pressure / Q000187:drug effects; D015170:Cerebrospinal Fluid Pressure / Q000187:drug effects / Q000502:physiology*; D003250:Constriction; D004285:Dogs; D004322:Drainage; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects; D005292:Ferricyanides / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D009599:Nitroprusside / Q000627:therapeutic use*; D010264:Paraplegia / Q000517:prevention & control; D010477:Perfusion; D011292:Premedication; D011897:Random Allocation; D013116:Spinal Cord / Q000187:drug effects / Q000502:physiology*
D005292:Ferricyanides; D009599:Nitroprusside; D008775:Methylprednisolone